Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00260200 | NJ |
NPI | 1053480475 |
---|---|
Provider Name | Dr. Vikas S. Bawa |
First Address | Columbus, NJ 08022-2248 |
Second Address | Newark, NJ 07102-2397 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 04/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8560005 | (05) | NJ |
U80247 | (02) | NJ |